Experts say tuberculosis poses a nearly silent threat

They implore journalists to cover the disease

By Sibyl Shalo, R.N.
NYC Metro chapter co-chair

Hear "tuberculosis" and think Brontë sisters? Consumption? The developing world? Think again: According to a panel of experts at a recent AHCJ New York City Metro chapter event, tuberculosis is alive and well and living in major cities and rural areas in the United States and all over the developed world. An audience of about 40 journalists and students learned that a devastating threat is posed by multi-drug resistant (MDR) and extensively drug resistant (XDR) tuberculosis, caused by inadequate and outdated prevention and treatment efforts.

Lee Reichman, M.D., M.P.H., executive director of the New Jersey Medical School Global Tuberculosis Institute, and professor of medicine and preventive medicine at UMDNJ-New Jersey Medical School, opened the evening with an overview of the global burden of tuberculosis, its lethal synergy with HIV (up to 50 percent of HIV deaths are caused by tuberculosis), and the root causes of tuberculosis drug resistance. He said that 1,770,000 people die of tuberculosis annually, 98 percent of them in developing nations. In comparison, H1N1 had killed 4,108 as of September 2009 but it receives exponentially more attention from the media. His contention: That reporters and editors don't think tuberculosis is "sexy enough" for their audiences.

Donald G. McNeil Jr., science and health reporter for the The New York Times, has written extensively about tuberculosis as one of the world's diseases of poverty. Responding to Reichman's and other panelists' complaint that tuberculosis is virtually ignored by the media, he read a list of specific New York Times headlines supporting his assertion that tuberculosis is covered when there's news, but news happens slowly in tuberculosis. The problem is, he explained, journalists can't be cheerleaders for even the best causes. And covering incremental advances in research or updated statistics in parts of the world that are already known to be epicenters of disease risks creating cynicism among readers who would be desensitized to future stories.

In his presentation, Mel Spigelman, M.D., president and CEO of the Tuberculosis Alliance, reviewed the global tuberculosis tool pipeline the more than 20 programs underway to develop it. He described the promise of the nonprofit international product development partnership business model, in which industry, academia, and foundations/financiers collaborate to expedite the historically slow tuberculosis research and development process. Their goal is to develop a drug that will shorten treatment from a six- to 30-month ordeal to a manageable 10-day course.

Chrispin Kambili, M.D., on loan from the CDC, is assistant commissioner and director of the Bureau of Tuberculosis Control for the New York City Department of Health and Mental Hygiene. He presented a strong case for keeping budgets steady in cities' efforts to control tuberculosis, despite declining infection and/or death rates. He showed data revealing a doubling of tuberculosis cases in New York City from 1985 to 1992. This, he and other experts argue, was a direct result of a severe (and misguided) reduction in tuberculosis spending, from $40 million in 1968 to a shocking $2 million in 1978. Today, Kambili attributes NYC's all-time low 895 cases (still 2.5 times the national average) to among other things, the expansion of directly observed therapy (DOT) programs, an adequate supply of the right drugs, and the political will to maintain adequate public health funding.

AHCJ member Janice Hopkins Tanne, who co-authored "Timebomb: The Global Epidemic of Multi-Drug Resistant Tuberculosis" with Reichman, described her experiences interviewing Russian scientists and clinicians for the book on their turf. Besides the obvious language barriers and safety concerns (no negative pressure rooms), she found herself in the middle of heated meetings between American and Russian scientists, who clashed on nearly every issue, from prevention and treatment to research priorities and finance. She advised journalists interested in covering tuberculosis that there are plenty of stories that deserve to be told, some here in the United States (the success of directly observed therapy programs) some in Africa (research and treatment partnerships in Tugela Ferry, South Africa, where the first XDR-TB case was documented), and everywhere in the world where shrinking public health budgets threaten to dismantle all the work that's been done to keep tuberculosis under control. Because, as she says, "TB is only an airplane ride away."

About the panel

AHCJ's New York City chapter met on Sept. 30, 2009, for a discussion about "Tuberculosis: AIDS of the 21^st Century?"

Tuberculosis is one of the most devastating epidemics of our time. But it receives relatively little attention from the media in relation to the 1.8 million deaths (and 9.3 million cases) it causes annually. Even worse, is the growing epidemic of multidrug resistant tuberculosis (MDR-TB), which is greatly undermining gains in controlling TB particularly among those with HIV/AIDS. Recent data show that 25 percent of people dying of TB are HIV.

An expert panel of scientists and journalists make the case that health journalists must be prepared to cover MDR-TB and to persuade editorial leadership of its urgency.

Among infectious diseases, only HIV is responsible for more deaths globally, and an estimated third of the world is infected with TB in its latent form. Recent developments suggest multiple story ideas and angles, including:

• The need for new and increased funding of TB R&D and global TB control by the US government and the international community

• The impact of investment, Millennium Development Goals/Global Plan to Stop TB targets, funding gaps.

• The economic impact on individuals, families, businesses, and society in both developed world and developing nations.

• Advances in R&D efforts to treat TB.

• The growing and dire public health threat of MDR-TB and extensively drug-resistant tuberculosis (XDR-TB).